Successful desensitization and early outcomes in two highly sensitized living-related kidney transplant recipients at IBN Sina Teaching Hospital, Sirte, Libya

Highly sensitized kidney transplant candidates face significant immunologic barriers due to high donor-specific antibody (DSA) titers. This study reports the first two highly sensitized living-related kidney transplant recipients successfully desensitized at Ibn Sina Teaching Hospital, Sirte, Libya, using plasmapheresis and rituximab without IVIG. Both patients exhibited DSA >5000 Mean Fluorescence Intensity (MFI) pre-desensitization. After 5–7 plasmapheresis sessions and rituximab, DSA levels fell below 500 MFI, permitting safe transplantation. Both received ATG induction and standard maintenance therapy. Immediate graft function occurred with serum creatinine <1 mg/dL at 72 hours. No delayed graft function, rejection, or infection occurred. These findings demonstrate that simplified desensitization can expand transplant access in developing countries.